2 per 100,000 college participants, or an overall rate of
0.6 per 100,000 cheerleaders (Boden et al, in press).
- In 2000 the CPSC estimated a total of 1258 head
injuries in cheerleaders of which 604 were recorded as
concussions and 6 as skull fractures. In the same year
there were 1814 neck injuries with 76 fractures in
cheerleaders that initially presented to an emergency
department in the United States (www.cpsc.gov). - Compared with other sports, cheerleading has a low
overall incidence of injuries, but a high risk of cata-
strophic injuries. - The majority of injuries occur in female athletes
because there are more female than male cheerleaders
and the women are usually at the top of the pyramid or
being thrown into the air during basket tosses. The
majority of injuries occur during the winter months,
because cheerleaders perform on indoor hard surfaces. - College athletes are five times more likely to sustain a
catastrophic injury than their high school counterparts
(Boden et al, in press). This finding is likely owing to
the increased complexity of stunts at the college level. - Catastrophic head injuries are twice as common as
cervical injuries.
MECHANISMS
- The most common stunts resulting in catastrophic
injury are the pyramid or the basket toss. The cheer-
leader at the top of the pyramid is most frequently
injured. A basket toss is a stunt where a cheerleader is
thrown into the air, often between 6 and 20 ft, by
either three or four tossers. Poor judgment or inade-
quate training of the spotter is often the main problem
leading to injury. - Less common mechanisms include advanced floor
tumbling routines, participating on a wet surface, or
performing a mount. The majority of injuries occur
when an athlete lands on an indoor hard gym surface
(Boden et al, in press).
PREVENTION
- Height restrictions on pyramids are limited to two
levels in high school and 2.5 body lengths in college
(www.ncaa.org; http://www.nfhs.org)..) The top cheerleaders
are required to be supported by one or more individu-
als (base) who are in direct weight-bearing contact
with the performing surface. The base cheerleaders
must remain stationary and maintain constant contact
with the suspended or top athlete. Spotters must be
present for each person extended above shoulder level.
The suspended person is not allowed to be inverted
(head below horizontal) or to rotate on the dismount.
Limiting the total number of cheerleaders in a pyramid
as well as the quick transitions between pyramids and
other complex stunts may also help reduce injuries.- Basket toss rules limit the stunt to four tossers, starting
the toss from the ground level (no flips) and having
one of the tossers behind the top person during the toss
(www.ncaa.org; http://www.nfhs.org)..) The top person (flyer)
is trained to be directed vertically and not allow the
head to drop backward out of alignment with the torso
or below a horizontal plane with the body. Other safety
measures that may reduce the incidence of basket toss
injuries include evaluating the height thrown, using
mandatory landing mats for complex stunts, and
improving the skills of the spotters. - All stunts should be restricted when wet conditions
are present. - Injuries from floor tumbling routines can be prevented
by proper supervision, progression to complex tum-
bling only when simple maneuvers are mastered, and
using spotters as necessary. - Minitrampolines, springboards, or any apparatus used
to propel a participant have been prohibited since the
late 1980s.
•A landing mat should be employed during all complex
stunts. - Cheerleading coaches need to place equal time and
attention on the technique and attentiveness of spot-
ters in practice compared with the athletes’ perform-
ing the stunts. - Coaches are encouraged to complete a safety certifi-
cation, especially for any teams that perform pyra-
mids, basket tosses, and/or tumbling. - Pyramids and basket tosses should be limited to expe-
rienced cheerleaders who have mastered all other
skills and should not be performed without qualified
spotters or landing mats.
- Basket toss rules limit the stunt to four tossers, starting
BASEBALL
EPIDEMIOLOGY
- Baseball has a low rate of noncatastrophic injuries,
but a high incidence of catastrophic injuries. - Head injuries constitute the majority of catastrophic
injuries. - There are approximately two direct catastrophic injuries
reported to the NCCSIR per year or 0.6 injuries per
100,000 participants (Mueller and Cantu, 2000). The
total incidence of catastrophic injuries and fatalities is 5
and 13 times higher, respectively, at the college level
than at the high school level (Boden et al, unpublished).
MECHANISMS
- The most common mechanism is a pitcher hit by a
batted ball, followed by a collision of two fielders, and
a collision of a runner and a fielder (Boden et al,
unpublished). An area of controversy in baseball is the
28 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE